DSHS COMMUNITY MENTAL HEALTH CRISIS SERVICES IMPLEMENTATION OVERVIEW MEETING Thursday, August 2, 2007 9:30 a.m. – 4:00 p.m.

AGENDA Welcome and Introductions – Joe Vesowate 9:30 am Opening Remarks – Dr. Lakey 9:45 am Review of Committee’s Work – Joe Vesowate 10:00 am Results of Legislature – Kirk Cole 10:30 am Implementation Overview – Mike Maples 10:45 am Break for Lunch 11:30 am Committee Discussion – Implementation Overview 12:45 pm Public Comment 2:15 pm Final Comments – Committee Members 3:45 pm *Adjourn 4:00 pm *The adjournment time may be extended to 4:30 p.m. to allow more time for public comment, if needed.

Please send comments to CrisisRedesign@dshs.state.tx.us

OPENING REMARKS

OVERVIEW OF CRISIS REDESIGN COMMITTEE

CRISIS REDESIGN COMMITTEE Medical professionals (TSPP, Medical Directors of MH Centers) Hospitals (THA, Hospital Districts) Law enforcement (Sheriffs, Police) Judges Advocacy organizations (MHA, NAMI, Advocacy, Inc., et al) Community MH centers DSHS staff

CHARGE Develop recommendations for a comprehensive array of specific services to meet the needs of Texans having a mental health and/or substance abuse crisis

WORK PROCESS Evaluation of existing services and data review Review of biomedical and social services literature Public testimony Formation of four subcommittees Clinical Design Rural Collaboration Finance Report

NEED FOR MENTAL HEALTH AND SUBSTANCE ABUSE CRISIS REDESIGN

Projected Number of Persons Needing Crisis Services to Increase Dramatically Compared to that Expected from a General Population Increase Note: Projected number of persons needing crisis services based on 13% increase in number receiving front-door crisis services from FY2005 to FY2006 projected forward each year, and 5% increase in number receiving community mental health services from FY2005 to FY2006 projected forward each year, 21% of whom receive community crisis services. Expected general population estimates based on 2.01% increase in Texas population (all ages) each year from 2005 to 2009. Sources: DSHS Mental Retardation and Behavioral Health Outpatient Warehouse (MBOW); Texas Population Percent Change, All Ages, 2004-2010, Texas Data Center.

BACKGROUND The committee was composed of more than 20 individuals representing local government, mental health professionals, hospitals, judges, law enforcement, advocacy organizations, local mental health authorities and DSHS staff.

COMMUNITY SURVEYS

COMMUNITY SURVEYS 1600 surveys were mailed before September 1, 2005. 700 returned for overall return rate of 44%. 570 to Community Hospital Emergency Departments 258 were returned for a response rate of 45% 1030 to Law Enforcement, Sheriff Departments, Chiefs of Police 442 returned for a response rate of 43%

SURVEY RESULTS Primary concerns of both Hospital/ER staff and Law Enforcement: Timeliness of MHMR response Use of “No Harm Contracts” Issues related to requiring medical clearance Need for improved communication and coordination Law Enforcement also frequently mentioned: Issues related to substance abuse Need for more procedures and written agreements with LMHAs All appeared to recognize the need for coordination to improve the system.

SITE VISITS AND HEARINGS February 7, 2006 – San Antonio February 15, 2006 – Austin February 23, 2006 – Big Spring February 27, 2006 - Harlingen

CRISIS THEMES

MAJOR ISSUES Information Attitude of providers Specialists – competent, well-trained, appropriate attitude No harm contracts Standardized approach – assessment, services, etc.

MAJOR ISSUES Training – crisis workers - assessment, suicide, substance abuse, law enforcement (CIT, MH Deputies), families Integration with health Medical evaluations/clearance – waiting time, consistency Attention to families Mobility orientation

MAJOR ISSUES Types of services – crisis hotline, mobile outreach, 23 hr. evaluation, residential, trained law enforcement, etc. Jail as an option – due to long waiting time, lack of options, unreceptiveness Need for forensic system – individuals who may be dangerous Courts – mental health and substance abuse

MAJOR ISSUES Transportation – responsibility, availability, distance, cost, diversion of resources Rural issues – distance, transportation, lack of professionals (MH/SA, healthcare, law enforcement), telemedicine Involuntary status as admission criteria for state hospitals Financial resources necessary

MAJOR ISSUES Children Data Cultural competency Collaboration Outpatient services

SUBCOMMITTEES Clinical Services Rural Finance Collaboration and Partnerships * Special issue subcommittee - Transportation

CORE CRISIS SERVICES REPORT RECOMMENDATIONS Crisis Hotline 23-48 Hour Observation Crisis Outpatient Services Community Crisis Residential Services Mobile Outreach Law Enforcement Crisis Intervention Team (CIT) and MH Deputy Programs

RESULTS OF LEGISLATURE

FUNDING FOR MH CRISIS SERVICES REDESIGN For the Years Ending Aug. 31, 2008 Aug. 31, 2009 $27,317,890 $54,682,110

DSHS BUDGET RIDER Use methodology that allocates a portion of the funds to achieve equity in state funding among local mental health authorities, a portion on a per capita basis, and a portion using a competitive process. DSHS to submit allocation plan to Legislative Budget Board (LBB) and Governor prior to distribution of funding. DSHS to report quarterly to LBB and governor on implementation of community mental health crisis services.

DSHS BUDGET RIDER DSHS to develop performance measures for quarterly reporting, which may include: Number of new psychiatric emergency 23/48 hour observation sites; Number of persons receiving 23/48 observation, mobile outreach, and children’s crisis outpatient services; Mental health relapse and hospitalization rates for clients receiving crisis services;

DSHS BUDGET RIDER Number of DSHS-funded staff with hotline certification; Percent of stakeholders satisfied with crisis services; and Criminal justice recidivism rates for clients receiving crisis services.

DSHS BUDGET RIDER DSHS to contract with independent entity for an evaluation of community mental health crisis services. Evaluation to include analysis of the implementation of crisis services. Evaluation to include analysis of the impact of crisis services on clients, local communities, mental health and health care providers, and law enforcement.

DSHS BUDGET RIDER DSHS to submit evaluation to LBB, Governor, and standing committees of Senate and House of Representatives having primary jurisdiction over health and human services by January 1, 2009.